Provider Demographics
NPI:1265565683
Name:UPHAM, SUSAN B (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:B
Last Name:UPHAM
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:34 RIVERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7742
Mailing Address - Country:US
Mailing Address - Phone:207-967-4835
Mailing Address - Fax:
Practice Address - Street 1:323 MARGINAL WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2543
Practice Address - Country:US
Practice Address - Phone:207-780-6631
Practice Address - Fax:207-780-6320
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME0139052083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine